Germany's healthcare system is excellent once you understand its structure. The core concept to grasp is that Germany has two separate insurance tracks — and which track you're on determines almost everything about how you access care.

GKV vs PKV: The Two-Track System

GKV — Gesetzliche Krankenversicherung (Statutory Health Insurance)

GKV is the default public health insurance system. If you're employed in Germany and earning below the contribution threshold, you're automatically enrolled in GKV. Most employees, students, and long-term residents are GKV members.

For gay and bisexual men, GKV is the better deal because:

  • PrEP medication is free on GKV (since 2019)
  • Mpox, Hepatitis A/B vaccines are free as Indikationsimpfungen
  • PEP is covered
  • HIV treatment (if needed) is fully covered

Your GKV card is the Gesundheitskarte — the electronic chip card you present at every appointment.

GKV contribution: Roughly 14–17% of gross income (split between you and your employer), with a cap.

PKV — Private Krankenversicherung (Private Health Insurance)

PKV is private health insurance, available to high earners (above the Versicherungspflichtgrenze, currently ~€69,000/year), civil servants, and the self-employed. Some freelancers choose PKV.

PKV can offer more flexibility — sometimes faster appointments, private rooms in hospital — but it has important downsides for sexual health:

  • PrEP coverage varies by policy; many PKV plans do not cover it
  • You pay upfront and claim back from your insurer (no card swipe at the counter)
  • Some sexual health services may have exclusions in cheaper PKV policies

If you're on PKV and need PrEP or sexual health services, check your policy documentation explicitly for HIV prevention coverage.

The Quartal System

Germany divides the year into four billing quarters:

Quarter Dates
Q1 1 January – 31 March
Q2 1 April – 30 June
Q3 1 July – 30 September
Q4 1 October – 31 December

Why this matters:

  1. Überweisungen (referrals) expire at the end of each quarter. A referral to a Schwerpunktarzt obtained in March is only valid until 31 March.
  2. Specialist appointment slots often reset at the start of a quarter — the best time to call for new patient appointments is Q1 start (2 January) or Q2 start (1 April).
  3. Your GP billing resets each quarter — you won't be charged an additional co-pay for visiting the same GP multiple times within the same quarter.

Kassenrezept vs Privatrezept

When a doctor prescribes medication in Germany, they write either a Kassenrezept (GKV prescription, pink form) or a Privatrezept (private prescription, blue form).

Kassenrezept Privatrezept
Who uses GKV patients PKV or self-pay
Medication cost Covered by GKV (small copay €5–10/pack) You pay full cost
PrEP Free on Kassenrezept via Schwerpunktarzt €50–100/month on Privatrezept
Access Only from authorised prescribers Any licensed doctor

If you're GKV and your Schwerpunktarzt writes you a Kassenrezept for PrEP, you pay nothing (or minimal copay). If they write a Privatrezept — or if you self-pay — you pay the full medication price at the pharmacy.

The Überweisung (Referral)

To see a specialist on GKV, you generally need an Überweisung from your Hausarzt (GP). This is a paper form (increasingly electronic) that authorises the specialist visit to be billed to GKV.

Key rules:

  • The Überweisung is valid only within the same quarter.
  • Without it, the specialist may charge you privately (Privatpatient rate) or refuse to see you.
  • Exception: Some Schwerpunktpraxen will see you as a Privatpatient for an initial consultation and then transition you to GKV — useful if the quarter is about to end and you can't get a Kassenüberweisung in time.

What to say to your GP:

"Ich brauche eine Überweisung zum Schwerpunktarzt für HIV-Medizin." ("I need a referral to an HIV specialist.")

Zuzahlung (Copayments)

GKV patients pay small copayments in certain situations:

  • GP or specialist visits: No copay since 2013 (the old Praxisgebühr was abolished).
  • Medication: €5–10 per pack, with annual out-of-pocket caps (~2% of gross income; 1% for chronically ill patients). PrEP generics are covered with no or minimal copay.
  • Hospital stays: €10/day for up to 28 days per year.
  • If copays are a hardship: Apply for Zuzahlungsbefreiung (copay exemption) through your Krankenkasse.

What If You Have No Insurance?

If you're between jobs, newly arrived, or otherwise uninsured in Germany:

  • Community testing at Checkpoints and Gesundheitsämter is generally accessible regardless of insurance.
  • PEP at Notaufnahme must legally be provided; you'll receive a bill, but emergency treatment cannot be withheld.
  • Some Aidshilfe organisations have social workers who can help navigate uninsured access to care.
  • If you're an EU citizen, your EHIC (European Health Insurance Card) covers medically necessary treatment in Germany — not PrEP, but emergency care including PEP.

Related